Reducing high intraocular pressure with hypertonic saline before eye surgery

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Abstract

Purpose

To compare the effect of intravenous hypertonic saline (IVHTS) on intraocular pressure (IOP) among patients with exfoliation glaucoma (ExG), primary open-angle glaucoma (POAG), and ocular hypertension (OHT).

Methods

A prospective, interventional trial. Included were patients with an IOP 24-30 mmHg with or without topical medication. Excluded were patients using oral acetazolamide medication, those with heart or kidney failure, dementia or other systemic condition that markedly decreased physical performance. Participants received a bolus of 23.4% IVHTS trough an antecubital vein. Infusion rate was 1 ml/s and dosage 1.0 mmol/kg sodium in all patients. We measured IOP before we injected the bolus (baseline), every minute after injection for 10 minutes, and then less frequently for 2 hours.

Results

A total of 35 patients participated (mean age 69 y, standard deviation [SD] 9); 16 ExG, 13 POAG, and 6 OHT patients. The baseline IOP 26.2 (SD, 1.7) mmHg was significantly reduced two minutes after treatment to 22.4 (SD, 2.6) mmHg (P<0.001). Maximum IOP reduction was achieved after 10 minutes, at which time IOP was reduced to 17.3 (SD, 2.9) mmHg (P<0.001), and the mean percentage IOP reduction was 34% (SD, 9). Mean IOP reduction was similar between groups (P=0.351; One-Way ANOVA). Two hours after treatment, the mean percentage IOP reduction was 26% (SD, 14). Within 1-2 minutes of treatment, 31 patients felt some sensation (pain, pressure) in the infusion arm, and 22 patients reported a feeling of warmth in their head.

Conclusion

Hypertonic saline seems to be an effective and a rapid method to reduce IOP. This reduction seems to be independent of topical medication or glaucoma subgroup. IVHTS could be a practical method to reduce IOP before or during eye surgery.

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